This proposal, a collaborative effort involving investigators in the basic and clinical departments at Harvard Medical School (HMS) and four of its major teaching and research affilates (Brigham and Women's Hospital (BWH), Beth Israel Hospital (BIH), Massachusetts General Hospital (MGH), and Joslin Diabetes Center (JDC), seeks support to establish an inter-institutional mulitdisciplinary Kidney Center devoted to a comprehensive understanding of nephropathy in diabetes mellitus. The emphases in this initiative are threefold; 1) to attract new scientific expertise to the intensive study of the basic molecular, cellular and physiological mechanisms of kidney injury in diabetes; 2) to exploit the strengths of the component institutional programs by establishing meaningful and unrestricted inter-institutional, interdisciplinary collaborative research initiatives; and 3) to extend these basic research initiatives to timely and innovative clinical and epidemiological studies of the pathogenesis, treatment and prevention of the nephropathy of this common metabolic disorder. Several specific basic and clinical research studies of diabetic nephropathy are already funded and in progress; the investigators involved in these studies have agreed to share their facilities, approaches and experience and will participate fully in the activities of the proposed Kidney Center, including its planned teaching and research conferences, annual symposia and extensive laboratory and clinical training programs. It is our belief that this proposed Center will foster an acceleration in the acquisition of knowledge in the general area of diabetic and other renal diseases and thereby contribute to improved care of patients.